Prurigo nodularis is a stubborn skin disorder impacting around 88,000 adults in the US, causing many sufferers a great deal of physical and emotional distress. The condition is notoriously difficult to manage, partly due to our limited knowledge about how it is caused.
There are currently many clinical trials being conducted to examine this condition in greater depth, explore new treatments, and potentially find a cure.
Other than medical intervention, there are several steps you can take to help minimize its unpleasant symptoms and appearance, and potentially stop it from recurring.
Interested in joining a clinical trial for Prurigo Nodularis?
Find and match with clinical trials that suit your needs and eligibility through our platform. Take the first step towards accessing innovative treatments today!
What is prurigo nodularis?
Prurigo nodularis is an irritating skin condition that causes hard, itchy bumps to appear on the skin, usually on the arms, legs, back, or abdomen. It can be extremely difficult for sufferers to avoid itching or picking at the resulting rash, which will likely contribute to making it worse.
The disorder can be more prevalent in people suffering with other skin issues, or with underlying illnesses such as HIV, cancer, kidney disease, or diabetes.
How common is prurigo nodularis?
Population research about prurigo nodularis suggests that 72 in 100,000 people in the US suffer from it, or 87,634 people a year aged 18–64. However, it’s likely that some cases aren’t diagnosed or reported, so these numbers could be significantly higher.
What causes prurigo nodularis?
The exact cause of prurigo nodularis is not known, but it’s commonly believed that symptoms stem from a dysregulation of the skin’s nerves and immune system. Studies of prurigo nodularis support this, showing a decrease in nerve fibers in the outer layer of the skin, and an increase in the deeper skin layer.
However, prurigo nodularis is also thought to be a secondary symptom of other, itchy skin diseases.
Conditions related to prurigo nodularis
According to the American Academy of Dermatology Association, around half of all patients have a history of atopic eczema. Other skin conditions related to prurigo nodularis include cutaneous T-cell lymphoma, lichen planus, xerosis cutis, keratoacanthomas, and bullous pemphigoid.
There’s also a link between prurigo nodularis and underlying medical conditions, such as kidney failure, liver disease, thyroid disease, lymphoma, HIV, hepatitis C, and some bacterial and parasitic infections.
What are the symptoms of prurigo nodularis?
The symptoms of prurigo nodularis are usually raised, hard bumps on the skin which can appear in a variety of shades. They will usually be incredibly itchy, and sometimes burn or sting.
Some people will have relatively few spots, whilst others might have a large rash with hundreds of nodules. All cases usually require medical treatment and it is unlikely to clear up on its own.
Learn more about the symptoms, causes, and possible complications associated with prurigo nodularis in our detailed guide.
How is prurigo nodularis diagnosed?
It can be difficult to distinguish prurigo nodularis from other, similar conditions, but a medical professional or dermatologist will be able to give you an accurate diagnosis.
They will likely complete microscopic examinations to check for abnormalities. They could involve a dermoscopy which examines your skin in-situ, a biopsy which involves extracting a small amount of skin, or a combination or both. Fewer nerve fibers in the epidermis and an increase of nerve fibers in the dermis are typical symptoms.
They might also measure your blood count and basic metabolic panel, and complete a urinalysis to test for underlying conditions that might be the cause.
Treatment for prurigo nodularis
The primary aim of current prurigo treatments is to break the cycle of itching and scratching, and remedies can often be used in conjunction with one another for maximum impact. A medical professional will advise you on the best course of action, and treat any underlying conditions that could be causing it.
Injections
Injections can provide immediate effective relief from the itching, pain, inflammation, and redness associated with prurigo nodularis. They’re particularly suitable if other treatments have failed to have an impact.
Targeted intralesional corticosteroid injections are most commonly used, which help by reducing inflammation, suppressing the immune response, and promoting healing.
However, whilst they are effective, they do present risks, with side effects including skin thinning, changes in coloration, and atrophy at the injection site. Plus they’re not suitable for long-term use due to the risk of systemic side effects.
Topical treatments
Topical treatments are suitable for mild to moderate cases of prurigo nodularis, or as an additional treatment for more severe cases.
How effective they are depends on your unique skin response, skin type, and how advanced the condition is, and it might take some trial and error to find the best approach.
Topical treatments for prurigo nodularis include:
- Corticosteroids: These reduce itchiness, inflammation, and the formation of new nodules. Mild to moderate cases may respond well to low to mid-potency topical corticosteroids. However, long-term use of potent corticosteroids should be avoided due to the risk of skin thinning and other side effects.
- Calcineurin Inhibitors: These include tacrolimus and pimecrolimus, which are immunosuppressants that reduce itching and inflammation. However, some people may experience a burning sensation on application.
- Antihistamines: Topical antihistamines can offer some relief from itching, but their effectiveness is limited.
- Emollients and moisturizers: Keeping your skin moisturized can provide symptomatic relief, but again, the effectiveness is limited.
- Capsaicin: This desensitizes nerve fibers and can provide relief over time. However, it might initially cause a burning sensation, and some people may experience further skin irritation.
Cryotherapy
Cryotherapy can be an effective option when other treatments have been unsuccessful. It works by applying liquid nitrogen or another cryogen directly to the affected nodules using a specialized device. The extreme cold causes rapid freezing of the targeted tissues, which destroys the cells.
This helps reduce the size of the nodules, alleviate itching, and improve the skin’s appearance. Multiple sessions may be needed to target particularly large or stubborn bumps.
Cryotherapy is generally safe, but side effects include temporary discomfort, blistering, and discoloration at the treatment site. Anyone considering this as an option should discuss the potential benefits, risks, and expected outcomes with their healthcare provider.
Immunosuppressants
Immunosuppressants are medications that suppress the immune system and reduce inflammation. They are effective at managing prurigo nodularis, but due to the potential risks, they are usually reserved for severe cases, or when other treatments have failed. You might also receive this treatment if you have an underlying autoimmune disorder, such as lupus or psoriasis.
Common immunosuppressants used for prurigo nodularis include corticosteroids, methotrexate, cyclosporine, and azathioprine, each with individual side effects that can potentially be serious.
Your healthcare provider can explain the potential risks and benefits of each treatment, and will carefully monitor you if you decide to go ahead.
Phototherapy
Phototherapy (or light therapy) can effectively treat prurigo nodularis, particularly if other treatments have been unsuccessful, or other medications are unsuitable due to contraindications or side-effects.
During phototherapy, the skin is exposed to ultraviolet light to suppress the immune response, reduce inflammation, and alleviate itching. Treatments usually take place two to three times a week over two to three months. It is generally safe and effective, particularly when used alongside other medications. Although as with any treatment, its success varies depending on individual factors.
In very severe cases where other treatment hasn’t worked, it can be combined with a photosensitizing medication called psoralen which makes the skin more sensitive to UVA light. However, this is associated with an increased risk of skin cancer and other adverse effects.
Psychological treatment
The persistent itching, pain, appearance, and chronic nature of prurigo nodularis can lead to symptoms of stress, depression, and anxiety. However, psychological interventions can help manage the trauma associated with the condition, and may also address some of the behaviors which contribute to it, such as scratching or picking.
Psychological treatments for nodular prurigo might include cognitive behavioral therapy (CBT), stress management techniques such as meditation and breathing exercises, supportive psychotherapy, and habit reversal training.
A psychologist or psychiatrist who has worked with people with skin conditions will be best placed to advise on the most effective treatments, although any healthcare professional should be able to help you find an appropriate therapy.
Other therapies
A number of other therapies are also to treat of prurigo nodularis, such as:
- pulsed dye laser therapy which kills diseased cells
- excimer laser treatment – a type of phototherapy that can target stubborn bumps or patches
- cannabinoid treatment to reduce itch intensity by blocking histamine receptors
- ayurveda – some studies on ayurvedic and prurigo nodularis have suggested that this ancient, holistic approach can help, but it shouldn’t replace conventional treatment
Newer treatments
Relatively new treatments for prurigo nodularis include:
- naloxone intravenous and naltrexone oral mu-opioid receptor antagonists
- immunosuppressants such as cyclosporine and methotrexate
- gabapentinoids which are used to treat neuropathies
- nalbuphine and nemolizumab which are currently undergoing testing
- thalidomide, although this is a last resort due to the potential risks
Home remedies
There are a few things you can do at home to help alleviate the discomfort caused by prurigo nodularis and help avoid further irritation. These methods are suitable for anyone who needs a little additional help, although they should be used alongside the treatments recommended by a medical expert. You can try:
- applying an ice pack or cold compress to soothe itchy areas
- having a short, lukewarm bath with colloidal oatmeal which can calm the skin
- moisturizing regularly with petroleum jelly or a hypoallergenic cream
- using fragrance-free cleansers and soaps that are suitable for sensitive skin
- applying over-the-counter lotions that contain camphor, menthol, phenol, capsaicin cream, and pramoxine hydrochloride
- relaxation techniques such as yoga and meditation to combat the psychological stress
Clinical trials and studies
Clinical studies about prurigo nodularis will help us understand its pathophysiology and epidemiology so we can improve how we manage and diagnose the condition for much better patient experiences and outcomes.
For example, after trials, dupilumab was approved by the FDA in 2022 and became the first specific treatment for prurigo nodularis.
Other treatments that have undergone trials include thalidomide, lenalidomide, opioid receptor antagonists, neurokinin-1 receptor antagonists, and monoclonal antibody therapy.
There are currently several clinical trials for prurigo nodularis that are actively seeking participants.
How to prevent prurigo nodularis
Although it’s difficult to prevent prurigo nodularis, there are steps you can take to reduce your risk of getting it, and to minimize the severity of the symptoms. Taking into consideration the following points can help:
- Heat and sun exposure can make the problem worse, so wear sunscreen with an SPF of 30 or more, and shield problem areas from UV light with loose, breathable clothing, or by going in the shade. It’s also advisable to avoid activities that make you sweat.
- Trim and file your fingernails so they are short without sharp edges. This will make it less likely for you to break the skin if you scratch it, and it reduces the likelihood of carrying harmful bacteria that can cause secondary infections. You could also wear thin gloves to stop yourself from causing too much damage – especially in your sleep.
- Use cleansers and moisturizers that are gentle and designed for sensitive skin as they’re usually free from harsh fragrances, chemicals or alcohol which can cause irritation.
- If you already have prurigo nodularis, stop it from becoming worse by monitoring any swelling, tenderness, or pain, and contact a healthcare professional if you see signs of an infection, such as pus or discharge.
Does prurigo nodularis go away?
Prurigo nodularis rarely goes away on its own, and it can last several months or even longer. However, with the right treatment it can eventually subside, and you can avoid flare-ups by identifying your individual triggers.
The scars and discoloration left behind can be permanent, but a dermatologist can advise on the best course of action to minimize their appearance.
Conclusion
Prurigo nodularis is a chronic and unpleasant condition that can have a significant impact on an individual's physical and emotional wellbeing. A lot is still unknown about how it is caused, and therefore most treatments are currently limited to tackling the symptoms.
However, there are several steps you can take to alleviate the discomfort, and reduce the likelihood of it recurring or becoming worse. Always consult with a medical professional before you embark on a course of treatment as they will be able to advise on the most effective approach for your unique circumstances. You can also take additional steps at home to help manage it yourself.
Clinical trials for prurigo nodularis will delve deeper into the disease so we can understand it better, diagnose it easier, and find more powerful treatments to help the thousands of people who suffer from it every year. If you’re one of the many people seeking help, you could consider participating in clinical trials to help advance medical knowledge in this area.
FAQs
What are the complications of prurigo nodularis?
Common complications can arise from persistent scratching, which include scarring, skin discoloration, and thickened skin. Some people also suffer from sleep deprivation, along with psychological problems such as anxiety and depression resulting from the relentless discomfort and unpleasant appearance of the condition. Local infections may also occur where the skin is broken.
Is prurigo nodularis contagious?
Prurigo nodularis is not contagious, so you don’t need to worry about it transferring from one person to another. However, good hygiene is still recommended to help keep the condition under control.
What is it like living with prurigo nodularis?
Prurigo nodularis is a chronic condition and it can last for many years, which makes it particularly difficult to deal with. The intense itching, and sometimes burning and stinging, can be very difficult to deal with. It can also result in impaired sleep, and even lead to depression and anxiety. As such, it’s vital to seek medical treatment, along with support for the associated stress.
Does prurigo nodularis cause scarring?
The nodules associated with prurigo nodularis can be incredibly itchy and irritating, so it’s common for people to scratch them, which can cause more nodules to appear, which then triggers even more itching and scratching. Where the bumps have been scratched and the skin broken, scarring, and discoloration can be left behind.